naftiko: 1.0.0-alpha2
info:
  label: WellCare Member Care Coordination
  description: Unified care coordination capability combining WellCare FHIR Patient Access and Provider Directory APIs. Enables
    care managers, app developers, and member-facing apps to access a member's complete health record alongside in-network
    provider and facility information for coordinated care delivery across Medicaid and Medicare Advantage plans.
  tags:
  - Healthcare
  - FHIR
  - Care Coordination
  - Patient Access
  - Provider Directory
  - Managed Care
  - Medicaid
  - Medicare
  created: '2026-05-03'
  modified: '2026-05-06'
binds:
- namespace: env
  keys:
    WELLCARE_PATIENT_ACCESS_TOKEN: WELLCARE_PATIENT_ACCESS_TOKEN
    WELLCARE_PROVIDER_DIRECTORY_TOKEN: WELLCARE_PROVIDER_DIRECTORY_TOKEN
capability:
  consumes:
  - type: http
    namespace: wellcare-patient-access
    baseUri: https://partners.centene.com
    description: WellCare FHIR R4 Patient Access API for member health data.
    authentication:
      type: bearer
      token: '{{WELLCARE_PATIENT_ACCESS_TOKEN}}'
    resources:
    - name: patient
      path: /fhir/r4/Patient
      description: Patient demographic and identity resources.
      operations:
      - name: get-patient
        method: GET
        description: Get Patient by FHIR ID.
        inputParameters:
        - name: id
          in: path
          type: string
          required: true
          description: FHIR Patient resource ID.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: coverage
      path: /fhir/r4/Coverage
      description: Member insurance coverage and enrollment.
      operations:
      - name: list-coverage
        method: GET
        description: List Coverage for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        - name: _count
          in: query
          type: integer
          required: false
          description: Number of results per page.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: explanation-of-benefit
      path: /fhir/r4/ExplanationOfBenefit
      description: Claims and EOB data for medical, pharmacy, dental, and vision.
      operations:
      - name: list-explanation-of-benefit
        method: GET
        description: List Explanation of Benefit claims for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        - name: service-date
          in: query
          type: string
          required: false
          description: Filter by service date range.
        - name: type
          in: query
          type: string
          required: false
          description: Filter by claim type.
        - name: _count
          in: query
          type: integer
          required: false
          description: Number of results per page.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: condition
      path: /fhir/r4/Condition
      description: Member diagnosed conditions.
      operations:
      - name: list-conditions
        method: GET
        description: List Conditions for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: observation
      path: /fhir/r4/Observation
      description: Clinical observations and lab results.
      operations:
      - name: list-observations
        method: GET
        description: List Observations for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        - name: category
          in: query
          type: string
          required: false
          description: Observation category filter.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: medication-request
      path: /fhir/r4/MedicationRequest
      description: Prescribed medications and medication orders.
      operations:
      - name: list-medication-requests
        method: GET
        description: List Medication Requests for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        - name: status
          in: query
          type: string
          required: false
          description: Medication status filter.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: immunization
      path: /fhir/r4/Immunization
      description: Immunization records and history.
      operations:
      - name: list-immunizations
        method: GET
        description: List Immunizations for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: encounter
      path: /fhir/r4/Encounter
      description: Care encounters and visits.
      operations:
      - name: list-encounters
        method: GET
        description: List Encounters for a member.
        inputParameters:
        - name: patient
          in: query
          type: string
          required: true
          description: FHIR Patient ID.
        - name: date
          in: query
          type: string
          required: false
          description: Encounter date range filter.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
  - type: http
    namespace: wellcare-provider-directory
    baseUri: https://partners.centene.com
    description: WellCare FHIR R4 Provider Directory API.
    authentication:
      type: bearer
      token: '{{WELLCARE_PROVIDER_DIRECTORY_TOKEN}}'
    resources:
    - name: practitioner
      path: /fhir/r4/Practitioner
      description: Individual healthcare practitioners.
      operations:
      - name: search-practitioners
        method: GET
        description: Search practitioners by name, specialty, or NPI.
        inputParameters:
        - name: name
          in: query
          type: string
          required: false
          description: Practitioner name.
        - name: identifier
          in: query
          type: string
          required: false
          description: NPI or other identifier.
        - name: specialty
          in: query
          type: string
          required: false
          description: Specialty taxonomy code.
        - name: _count
          in: query
          type: integer
          required: false
          description: Results per page.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
      - name: get-practitioner
        method: GET
        description: Get Practitioner by FHIR ID.
        inputParameters:
        - name: id
          in: path
          type: string
          required: true
          description: FHIR Practitioner ID.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: organization
      path: /fhir/r4/Organization
      description: Healthcare organizations and facilities.
      operations:
      - name: search-organizations
        method: GET
        description: Search organizations by name, type, or NPI.
        inputParameters:
        - name: name
          in: query
          type: string
          required: false
          description: Organization name.
        - name: type
          in: query
          type: string
          required: false
          description: Organization type.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
      - name: get-organization
        method: GET
        description: Get Organization by FHIR ID.
        inputParameters:
        - name: id
          in: path
          type: string
          required: true
          description: FHIR Organization ID.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: location
      path: /fhir/r4/Location
      description: Care delivery locations.
      operations:
      - name: search-locations
        method: GET
        description: Search locations by ZIP code or proximity.
        inputParameters:
        - name: address-postalcode
          in: query
          type: string
          required: false
          description: ZIP code for location search.
        - name: near
          in: query
          type: string
          required: false
          description: Proximity coordinate search.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: practitioner-role
      path: /fhir/r4/PractitionerRole
      description: Practitioner network roles and affiliations.
      operations:
      - name: search-practitioner-roles
        method: GET
        description: Search practitioner roles and network affiliations.
        inputParameters:
        - name: practitioner
          in: query
          type: string
          required: false
          description: FHIR Practitioner ID.
        - name: organization
          in: query
          type: string
          required: false
          description: FHIR Organization ID.
        - name: specialty
          in: query
          type: string
          required: false
          description: Specialty code.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
    - name: insurance-plan
      path: /fhir/r4/InsurancePlan
      description: Insurance plan network and benefit details.
      operations:
      - name: search-insurance-plans
        method: GET
        description: Search insurance plans by name or type.
        inputParameters:
        - name: name
          in: query
          type: string
          required: false
          description: Plan name.
        - name: type
          in: query
          type: string
          required: false
          description: Plan type.
        outputRawFormat: json
        outputParameters:
        - name: result
          type: object
          value: $.
  exposes:
  - type: rest
    port: 8080
    namespace: wellcare-care-coordination-api
    description: Unified REST API for WellCare member care coordination.
    resources:
    - path: /v1/members/{id}
      name: member-profile
      description: Member demographic and identity.
      operations:
      - method: GET
        name: get-member
        description: Get member profile by FHIR Patient ID.
        call: wellcare-patient-access.get-patient
        with:
          id: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/members/{id}/coverage
      name: member-coverage
      description: Member insurance coverage and enrollment.
      operations:
      - method: GET
        name: get-member-coverage
        description: Get coverage for a member.
        call: wellcare-patient-access.list-coverage
        with:
          patient: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/members/{id}/claims
      name: member-claims
      description: Member claims history.
      operations:
      - method: GET
        name: get-member-claims
        description: Get EOB claims for a member.
        call: wellcare-patient-access.list-explanation-of-benefit
        with:
          patient: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/members/{id}/conditions
      name: member-conditions
      description: Member clinical conditions.
      operations:
      - method: GET
        name: get-member-conditions
        description: Get conditions for a member.
        call: wellcare-patient-access.list-conditions
        with:
          patient: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/members/{id}/medications
      name: member-medications
      description: Member active medications.
      operations:
      - method: GET
        name: get-member-medications
        description: Get medication requests for a member.
        call: wellcare-patient-access.list-medication-requests
        with:
          patient: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/members/{id}/encounters
      name: member-encounters
      description: Member care encounters.
      operations:
      - method: GET
        name: get-member-encounters
        description: Get care encounters for a member.
        call: wellcare-patient-access.list-encounters
        with:
          patient: rest.id
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/providers
      name: network-providers
      description: In-network providers.
      operations:
      - method: GET
        name: search-providers
        description: Search in-network providers by specialty or name.
        call: wellcare-provider-directory.search-practitioners
        with:
          name: rest.name
          specialty: rest.specialty
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/facilities
      name: network-facilities
      description: In-network facilities.
      operations:
      - method: GET
        name: search-facilities
        description: Search in-network hospitals and clinics.
        call: wellcare-provider-directory.search-organizations
        with:
          name: rest.name
          type: rest.type
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/locations
      name: care-locations
      description: Care delivery locations.
      operations:
      - method: GET
        name: search-locations
        description: Find care locations by ZIP code.
        call: wellcare-provider-directory.search-locations
        with:
          address-postalcode: rest.postalcode
        outputParameters:
        - type: object
          mapping: $.
    - path: /v1/plans
      name: insurance-plans
      description: Insurance plan information.
      operations:
      - method: GET
        name: search-plans
        description: Search insurance plans.
        call: wellcare-provider-directory.search-insurance-plans
        with:
          name: rest.name
          type: rest.type
        outputParameters:
        - type: object
          mapping: $.
  - type: mcp
    port: 9090
    namespace: wellcare-care-coordination-mcp
    transport: http
    description: MCP server for AI-assisted WellCare member care coordination.
    tools:
    - name: get-member-profile
      description: Get a WellCare member's demographic profile and contact information.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.get-patient
      with:
        id: tools.patient_id
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-coverage
      description: Get insurance coverage and enrollment details for a WellCare member.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-coverage
      with:
        patient: tools.patient_id
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-claims-history
      description: Get historical claims and EOB data for a WellCare member. Supports up to 5 years of history.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-explanation-of-benefit
      with:
        patient: tools.patient_id
        type: tools.claim_type
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-active-conditions
      description: Get active diagnoses and conditions for a WellCare member.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-conditions
      with:
        patient: tools.patient_id
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-medications
      description: Get current and historical medication prescriptions for a WellCare member.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-medication-requests
      with:
        patient: tools.patient_id
        status: tools.status
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-immunization-history
      description: Get immunization records and history for a WellCare member.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-immunizations
      with:
        patient: tools.patient_id
      outputParameters:
      - type: object
        mapping: $.
    - name: get-member-care-encounters
      description: Get care visit and encounter history for a WellCare member.
      hints:
        readOnly: true
        openWorld: false
      call: wellcare-patient-access.list-encounters
      with:
        patient: tools.patient_id
      outputParameters:
      - type: object
        mapping: $.
    - name: search-in-network-providers
      description: Search for in-network WellCare providers by name or specialty.
      hints:
        readOnly: true
        openWorld: true
      call: wellcare-provider-directory.search-practitioners
      with:
        name: tools.provider_name
        specialty: tools.specialty
        identifier: tools.npi
      outputParameters:
      - type: object
        mapping: $.
    - name: find-network-facilities
      description: Search for in-network hospitals, clinics, and healthcare facilities.
      hints:
        readOnly: true
        openWorld: true
      call: wellcare-provider-directory.search-organizations
      with:
        name: tools.facility_name
        type: tools.facility_type
      outputParameters:
      - type: object
        mapping: $.
    - name: find-care-locations-near-zip
      description: Find WellCare in-network care delivery locations near a ZIP code.
      hints:
        readOnly: true
        openWorld: true
      call: wellcare-provider-directory.search-locations
      with:
        address-postalcode: tools.zip_code
      outputParameters:
      - type: object
        mapping: $.
    - name: get-plan-information
      description: Get WellCare insurance plan details including network and benefit information.
      hints:
        readOnly: true
        openWorld: true
      call: wellcare-provider-directory.search-insurance-plans
      with:
        name: tools.plan_name
        type: tools.plan_type
      outputParameters:
      - type: object
        mapping: $.